TEST STRIPE CC 2026 Annual Conference Registration Step 1 of 6 16% PhoneThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the form(H) Conference Year2026Year of annual conference. Internal/administrative use only. Hidden.This field is hidden when viewing the formToday MM slash DD slash YYYY We are currently sold out of regular rooms for our upcoming meeting. Scientific Session registration is still open. Please contact Allison Dicaro if you have any questions. Registration InformationName(Required) First Last Email(Required) Enter Email Confirm Email Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhonePhone LabelCellOfficeHomeFaxBusiness NameGender Female Male Birth Date MM slash DD slash YYYY Passport InformationMember PassportPassport Number(Required)Passport Issue CityPassport CountryPassport Issue Date MM slash DD slash YYYY Passport Expiration Date(Required) MM slash DD slash YYYY SessionsRegistration Fee Price: Balance/Full payment is due on May 1, 2026.Meeting Package Physician and Guest - $12,275.00 Physician Only - $7,500.00 No package selected PLEASE NOTE: If you opt to pay by check you have 30 days to mail your check to the address below. If we do not receive your check within 30 days the credit card on file will be charged for the 30% deposit. NYS of the AUA Attn: Michele Paoli 4100 Duff Place Lower Level Seaford, NY 11783 Hotel Upgrade Imperial Upgrade- $1,450.00 No suite upgrade Room Details We are currently sold out of regular rooms for our upcoming meeting and only have suites available. The upgrade costs are listed above. View Room Descriptions Guest InformationGuest Name(Required) First Last Guest Email(Required) Enter Email Confirm Email Guest PhoneGuest Phone LabelCellOfficeHomeGuest PassportPassport NumberPassport Issue CityPassport Issue Date MM slash DD slash YYYY Passport CountryPassport Expiration Date MM slash DD slash YYYY This field is hidden when viewing the formGuest ToursGuest tour packages are being organized and will be announced when ready.This field is hidden when viewing the formPlease select a Tour Gastronomical Tour Luxemborg Gardens/Spanish Quarter No tour selected This field is hidden when viewing the formGuest ToursSunday, November 10(H) Group Tour: Orientation Walking Tour Old City Quantity Price: $0.00 Quantity (H) Tea Blending at Gladstone's Land Quantity Price: $0.00 Quantity (H) Bike Tour Quantity Price: $0.00 Quantity Monday, November 11(H) Majorelle Gardens & YSL Museum Quantity Price: $80.00 Quantity (H) Lunch at Al Baraka Quantity Price: $160.00 Quantity (H) Old Medina & Souk Quantity Price: $0.00 Quantity Tuesday, November 12(H) Moroccan Tagine cooking class with lunch Quantity Price: $160.00 Quantity (H) DIY Mosaic Workshop with a local artisan Quantity Price: $145.00 Quantity (H) Guided visit of the monuments Quantity Price: $0.00 Quantity Wednesday, November 13(H) Sunrise Hot Air Balloon Ride Quantity Price: $325.00 Quantity (H) Hiking in the high Atlas mountains Quantity Price: $0.00 Quantity (H) Day trip to Essaouira Quantity Price: $0.00 Quantity (H) Excursion to Terre d’Amanar Park Quantity Price: $0.00 Quantity (activities and lunch included)Thursday, November 14(H) DIY Moroccan Leather Workshop with a local artisan Quantity Price: $145.00 Quantity (H) Hammam & Spa Treatment Quantity Price: $215.00 Quantity Friday, November 15(H) Marrakech Modern Art Tour Quantity Price: $55.00 Quantity (H) Bike around Marrakech Quantity Price: $175.00 Quantity (H) Hiking San Sebastian Quantity Price: $0.00 Quantity This field is hidden when viewing the formTour 1 - (H)This field is hidden when viewing the formTour 2 - (H)This field is hidden when viewing the formTour 3 - (H) - SubtotalThis field is hidden when viewing the formTour 4 - Majorelle Gardens & YSL MuseumThis field is hidden when viewing the formTour 5 - (H)This field is hidden when viewing the formTour 6 - (H)This field is hidden when viewing the formTour 8a - Moroccan Taguibe Cooking Class w/lunchThis field is hidden when viewing the formTour 8c - DIY Mosaic WorkshopThis field is hidden when viewing the formTour 9a - (H)This field is hidden when viewing the formTour 10a - Marrakech Modern Art TourThis field is hidden when viewing the formTour 10b - DIY Moroccan Leather WorkshopThis field is hidden when viewing the formTour 11a - Bike around MarrakechThis field is hidden when viewing the formTour 11b - (H)This field is hidden when viewing the formTour 12a - Sunrise Hot Air BaloonThis field is hidden when viewing the formTour 12b - (H)This field is hidden when viewing the formTour 12c - (H)This field is hidden when viewing the formTour 12d - (H)This field is hidden when viewing the formTour 13a - Hamman & Spa TreatmentSubtotalCalculated subtotal This field is hidden when viewing the formPost-Trip Tour: TBD - Learn more Note: A minimum number of participants is required for this tour package and optional activities. Actual selections will be confirmed once the trip is confirmed.This field is hidden when viewing the formCanary Islands Tour - Nov. 16-18, 2024 Couple - $3,250.00 Single - $2,250.00 No tour selected *Discounted pricingThis field is hidden when viewing the formSubtotalCalculated subtotal Additional InformationWhere to send business documents Send to mailing address Send to other address entered below Other Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Alternative address where business documents will be mailed.Dining Information> Please specify your restaurant preference for Lunch on Tuesday, August 29th by ranking the choices below. Enter a number 1 to 3 to rank the choices.This field is hidden when viewing the formKaia-Kaipe1st2nd3rdThis field is hidden when viewing the formBelearri Getaria1st2nd3rdThis field is hidden when viewing the formTBD1st2nd3rdThis field is hidden when viewing the formNumber of people in party?Please enter a number from 1 to 10.Do you have any Allergies or Special Needs? Yes No Allergies/Special Needs DetailsDo you or your guest have any Dietary Requirements? Yes No Your Dietary Requirements DetailsGuest Dietary Requirements DetailsEmergency Contact First Last Someone NOT traveling with you.Emergency Contact Relationshipe,g, sibling, friend, otherEmergency Contact PhoneThis field is hidden when viewing the formAre you interested in attending the Post Trip to Iceland? Yes No This field is hidden when viewing the formWould you like a quote for Travel Insurance? Yes No Travel insurance is highly recommended.This field is hidden when viewing the formI have read and understand the Travel Insurance recommendation above(Required) I agree PaymentA credit card is required to register and will be charged within seven (7) days of registration. A 2.9% processing fee will be added. You have the option of paying by check. Payment Method [resolved](Required) Credit Card - Deposit (30% + 2.9% fee) Credit Card - Full (100% + 2.9% fee) Pay By Check Choose method of payment: Check or Credit CardSubtotalCalculated subtotalCredit Card Processing FeeCalculated fee based on payment methodTotal Amount Price: $0.00 Total Amount includes fee.30% Deposit Price: $0.00 Calculated deposit amount includes fee.Credit Card(Required) Cardholder Name(Required)Billing Information(Required) Same as registration address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country